It's the board Republicans would love to turn into this year's version of the "death panel," but Obama is firmly committed to the idea - so committed that his latest deficit reduction plan would give it even more power.

The question that's increasingly coming up in health policy circles, though, is: Who would want that job?

IPAB has become a huge lightning rod. It's unpopular with Republicans, who paint it as a group of bureaucrats trying to ration people's health care. House Budget Committee Chairman Paul Ryan (R-Wis.) has called it a "rationing board." Some Democrats don't like it either - they think it will take too many decisions away from Congress.

It's one of the biggest targets for Republican repeal efforts. Sen. John Cornyn (R-Texas) and Rep. Phil Roe (R-Tenn.) have introduced bills to get rid of the board. And if they can't do that, Senate Republicans have suggested they'll hold up Obama's nominations for the board, which have to be confirmed by the full Senate.

But even aside from the political controversy, the design of the board could make it an unattractive job for some of the nation's best-known health policy leaders. To avoid any conflicts of interest, they'd have to leave whatever job they're doing now for up to six years - the length of a full term.

"The problem is that this is a full-time job with a long appointment that would effectively require giving up an academic career, so I can't see many folks I know being interested in this," said Jonathan Gruber, a health economist at the Massachusetts Institute of Technology.

Gail Wilensky, a former administrator of the agency that oversees Medicare and Medicaid and a health care adviser to the first President George Bush, said it will be "hard to get appropriate people" for the board, given that they'd have to make it a full-time job and the Senate would go through every last detail of their records.

"You'd like to get known, senior people, but senior people tend to have a history," Wilensky said. "I think to get very senior people who have the expertise and who are confirmable will be a challenge."

The board is supposed to have a variety of health care stakeholders and researchers, including physicians, health economists, experts on the effectiveness of medical treatments, insurers, employers and consumer advocates. They're supposed to have six-year terms, though some of the early appointees would have shorter terms so the turnover would be staggered.

There aren't a lot of people in the health care field who are widely talked about as likely candidates. One of the only ones who is - David Cutler, a health care economist at Harvard University - says he hasn't had "any conversations with people who might be possibilities, nor have I thought about it at all myself."

And since board members would have to leave their jobs for a long time, some health care analysts privately suggest the perfect candidate would be a health care industry leader or researcher who's close to retirement and sees IPAB as a good last stop.

So far, the dialogue on possible nominees doesn't seem to have started. Under the law, Obama is supposed to consult with Senate Majority Leader Harry Reid (D-Nev.), Senate Minority Leader Mitch McConnell (R-Ky.), House Speaker John Boehner (R-Ohio) and House Minority Leader Nancy Pelosi (D-Calif.). But aides to McConnell, Boehner, and Pelosi say they haven't heard from the White House yet.

There's still time for that process to start. The board's first recommendations aren't due until 2014, and only if Medicare spending grows beyond a set target by then. (It's tied to the average of medical and general inflation).

But they can't wait forever - the law gives IPAB its first $15 million in startup funds in fiscal 2012. And the way things are going, it's hard to see either Boehner or McConnell recommending people for a board Republicans want to repeal.

The board is a crucial part of the cost containment strategies in the health care law. It's supposed to come up with ways to bring down Medicare spending, and they take effect automatically unless Congress comes up with a different way to save the same amount of money.

But it also has lots of restrictions on what it can and can't do. It can't touch hospitals or hospices until 2020, and it can't cut Medicare benefits, raise premiums or taxes, or change the eligibility rules. There's also a line in the law that specifically says it can't "ration health care" - and the board's opponents are likely to hold members to that, in the broadest possible ways.

So whoever sits on the board will have great power, in theory, but also lots of constraints. With 15 members on the board, any one member, other than the chairman, isn't likely to have a lot of influence.

And any nominee who has ever uttered anything controversial is sure to hear about it in the confirmation process - just as the famous "ration with our eyes open" quote pretty much destroyed Don Berwick's chances for Senate confirmation as administrator of CMS.

The Senate authors of the health care law intended IPAB to be modeled on the Medicare Payment Advisory Commission, which suggests payment rates to Congress and is well-stocked with prominent health industry officials and researchers. But the MedPAC members are allowed to keep their day jobs - and they don't have to find spending cuts that providers, and the public, are bound to hate.

"There's just a dramatic difference between the two," said Michael Chernew, a MedPAC commissioner and a health care policy professor at Harvard Medical School. "We don't sit around at MedPAC saying, 'Here's our budget target - how are we going to hit it?' As soon as you have a fiscal target, you're going to look at some questions differently."

Still, Chernew said the potential influence of sitting on IPAB could be enough of a draw to interest some of the people with the health care expertise the board will need.

"I would be surprised, really surprised, if there weren't people who want to do it," Chernew said. "If the argument is, 'You'll never get anybody to do it,' I suspect that's not the case."

This article first appeared on POLITICO Pro at 12:39 p.m. on May 13, 2011.